neurocognitive disorders

Question 1

delirium

Answer 1

Disturbance in attention
Abrupt onset with periods of lucidity
Disorganized thinking
Poor executive functioning
Disorientation
Anxiety and agitation
Poor recall
Delusions and hallucinations (usually visual)

• caused by medical
• resolves by treatment

Question 2

application of the nursing process

Answer 2

Overall assessment

• Four cardinal features of delirium
  1. Acute onset and fluctuating course
  2. Reduced ability to direct, focus, shift, and sustain attention
  3. Disorganized thinking
  4. Disturbance of consciousness

Question 3

what affected

Answer 3

Cognitive and perceptual disturbances

• Illusions: paperclip = big
• Hallucinations: visual- reaching out to something

Physical needs
Moods and physical behaviors: confusion, disoriented
Self assessment

Question 4

delirium diagnosis

Answer 4

• Risk for injury: great risk for fall, clear room, 2 side rail
• Acute confusion: memory impaired, locx4, neuro assessment
• Risk for deficient fluid volume: assist w meals
• Disturbed sleep pattern: quiet, lights dim, morning more lucid
• Impaired verbal communication: may not make sense
• Fear
• Self-care deficits: adls help
  I- mpaired social interaction: withdrawn, hypervilligent

Question 5

delirium outcomes criteria

Answer 5

• Patient will remain safe and free from injury
• During periods of clarity, patient will be oriented to time, place, and person
• Patient will remain free from falls and injury while confused, with the aid of nursing safety measures

Question 6

delirium planning

Answer 6

• Ensure necessary aids and supportive home team
• Visual cues in the environment for orientation
• Continuity of care providers

Question 7

delerium implementation

Answer 7

• Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance.
• Minimize use of restraints (increases confusion)
• Perform comprehensive nursing assessment to aid in identifying cause.
• Assist with proper health management to eradicate underlying cause.
• Use supportive measures to relieve distress.

Question 8

what is Major and Minor Neurocognitive Disorders

Answer 8

• Progressive deterioration of cognitive functioning and global impairment of intellect (dementia)
• No change in consciousness
• Difficulty with memory, problem solving, and complex attention
• Mild: Does not interfere with ADLs; does not necessarily progress
• Major: Interferes with daily functioning and independence

Question 9

major neuro

Answer 9

Alzheimer’s disease
Frontotemporal dementia
Dementia with Lewy bodies
Vascular dementia
Traumatic brain injury
Substance-induced dementia 
HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease

Question 10

clinical picture

Answer 10

• Alzheimer’s: 60% to 80% of all dementias
• Important to distinguish normal forgetfulness and memory deficits in dementia
• In dementia: memory loss interferes with ADLs

AD progression

• Mild
• Moderate
• Severe

Question 11

Ad mild

Answer 11

forgot how to get home, usually remember eventually, feeling shame and denial

Question 12

ad moderate

Answer 12

confusion increased, lost, wondering

Question 13

ad severe

Answer 13

complete total care, can’t communicate

Question 14

assessment of ad

Answer 14

Defense mechanisms
Denial (key)
Confabulation (creation of stories in place of missing memories to maintain self-esteem)
Perseveration (repetition of phrases or behavior)
Avoidance of questions
Self assessment

Question 15

confabulation

Answer 15

creation of stories in place of missing memories to maintain self-esteem

Question 16

preservation

Answer 16

repetition of phrases or behavior

Question 17

symptoms of alzheimers

Answer 17

• Memory impairment
• Disturbances in executive functioning: concrete thinking
• Aphasia: Loss of language ability
• Apraxia: Loss of purposeful movement
• Agnosia: Loss of sensory ability to recognize objects
• agraphia: dimished ability eventual inability to read and write
• sundowning: tendency for mood to deteriorate and agitation to increase later in day and night

Question 18

ad diagnosis test

Answer 18

Computed tomography scan (CT)
Positron emission tomography (PET)
Mental status questionnaires

Question 19

ad exams

Answer 19

• Complete physical and neurological exam
• Complete medical and psychiatric history: CBC, vitamin b12, folate
• Review of recent symptoms, meds (polyfarm can cause confusion), and nutrition: dehydration
• CAM for delerium

Question 20

self assessment for ad

Answer 20

• Realistic understanding of the disease
• Stress management
• Support and educational resources
• Realistic outcomes and recognition when these are achieved
• Maintaining good self-care

Question 21

nursing diagnosis for ad

Answer 21

Risk for wandering
Risk for injury (risk for injury)
Impaired verbal communication
Impaired environmental interpretation syndrome
Impaired memory
Confusion
Caregiver role strain
Anticipatory grieving

Question 22

interventions for ad

Answer 22

Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy

Pharmacological interventions

• ariept moderate to mild
• namenda moderate to severe
• namzarix moderate to severe

Question 23

community support

Answer 23

• Transportation services
• Supervision and care when the primary caregiver is out of the home
• Referrals to day care centers (9-5)
• Information on support groups in the community
• Meals on Wheels: provide meals
• Information on respite and residential services (drop off for weekend)
• Telephone numbers for help lines
• Home health services